Certolizumab pegol (Cimzia) — prior authorization under Humana
Billing code J0717 · Category: medications
In our reference, this procedure typically requires prior authorization.
Typical turnaround is 7 day(s); Humana's
standard turnaround is 14 calendar days (72 hours if urgent).
How to submit
Availity portal, Humana Provider Portal, 800-448-6262
Documentation typically required
Diagnosis documentation
Prior DMARD/biologic records
TB test
Common reasons this gets denied
Step therapy not completed
Prior biologic not tried
Humana-specific notes
Medicare Advantage has separate PA list from commercial
CareCore for advanced imaging
Post-acute care requires InterQual criteria
Coverage limits: this page does not confirm authorization for any specific member's plan, and does not cover state-specific plan variants, out-of-network requests, or every payer x procedure pair in existence. For a definitive answer, contact Humana directly using the submission method above.
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